Long ER waits: Half of state's hospitals over national average of 28 minutes

Published November 18. 2013 10:00AM

Updated November 19. 2013 10:55AM

By KATE FARRISH, Conn Health I-Team Writer

Publication: theday.com

In more than half of Connecticut's emergency rooms, the waiting time to see a health care provider exceeds the national average of 28 minutes — a problem that experts say could get worse, as thousands more residents obtain health insurance.

The average wait can stretch to an hour or more at Rockville General, Manchester Memorial, Bridgeport, Waterbury and Hartford hospitals, according to a C-HIT review of federal data. The statewide average waiting time is 30 minutes.

The longest wait time is at Hartford Hospital, where patients were not seen for 82 minutes, on average; the shortest wait of 14 minutes is at Windham Hospital, the data compiled by the Centers for Medicare & Medicaid Services (CMS) through 2012 show. Officials at Hartford and Bridgeport hospitals claim shorter wait times than the federal data.

Hospitals have taken some steps to improve their wait times, at a time when emergency departments have seen an increase in patients. But, experts say that the task is only going to get tougher, as the Affordable Care Act will expand the pool of eligible Medicaid recipients seeking care by at least 15 million nationally.

With a shortage of primary care physicians or those who won't accept new patients, ER visits are bound to increase in Connecticut when the ACA takes effect in 2014, said Dr. Gregory Shangold, medical director of Windham's emergency department.

"Insurance does not equal access to care,'' he said. "The emergency department is society's safety net."

Officials at several hospitals say they are streamlining their ER operations to shorten waits for walk-in patients. They note that patients who arrive by ambulances or with life-threatening conditions are seen right away. Some hospitals post their waiting times on their websites, so people will know what to expect.

At Hartford Hospital, where officials say the median door-to-provider time of 37 minutes is a better measure of its wait time than CMS' calculation, a "quick track'' room frees up ER beds while patients wait for lab results. Bridgeport Hospital, with an average ER wait time of 71 minutes, recently added two physicians to handle its 81,000 annual ER visits.

"The seven-hour wait went out with the tide,'' said Dr. Rockman Ferrigno, chairman of emergency medicine at Bridgeport Hospital. "We're all challenged by the same thing: how to provide quick, quality, compassionate care."

With an average ER wait of 42 minutes, Lawrence + Memorial in New London places a doctor in triage to shorten waits, said Dr. Oliver Mayorga, chairman of emergency medicine.

"This also improves the quality of care because it puts the most experienced set of eyes out there seeing patients right away," he said.

ER visits on the rise

The focus on ER waiting times comes as use is rising in Connecticut and around the country.

From 1997 to 2007, ER visits increased nationally by 23 percent, the Journal of the American Medical Association reports. The National Center for Health Statistics reports that mean ER waits also climbed, from 46.5 minutes in 2003 to 58.1 minutes in 2009.

In Connecticut, total ER visits increased by 55,000, or 3.2 percent, from 2011 to 2012, according to the state Office of Health Care Access annual hospital report. The six hospitals with the highest total ER volume were Yale-New Haven, Hartford, The Hospital of Central Connecticut, Middlesex, MidState and Lawrence + Memorial hospitals.

More patients are using the ER because the U.S. population is aging and the number of primary care physicians has not kept up with the demands of sicker people, said Dr. Robert C. Solomon of the American College of Emergency Physicians.

"More people are going to the emergency department because … no one gets turned away," said Solomon, an ER doctor in Pittsburgh.

Since Hartford is the only Level 1 trauma center in Greater Hartford, it may have longer waits than other hospitals, said Rebecca Stewart, spokeswoman for Hartford Hospital.

The other Level 1 trauma center in Connecticut, Yale-New Haven Hospital, has an average ER wait of 41 minutes, according to the data.

Dr. Jeffrey A. Finkelstein, chief of emergency medicine at Hartford Hospital and The Hospital of Central Connecticut, said Hartford is shortening its ER waits through several steps, including having a fast track for people with minor ailments.

The new Quick Track or Q Track program is also working well, he said, as other patients are monitored in a "results-pending area with 14 comfortable chairs, coffee and a big-screen TV.'' Q Track is novel, he said, because "it speeds the care for everyone."

At Windham, the average wait has been cut to 14 minutes by streamlining triage and moving patients to rooms quickly, Shangold said.

Hospitals are also working to cut down on the waiting time to be admitted as inpatients from ERs.

"Unfortunately, sometimes you have to put people in hallways in the ED,'' Shangold said. "It's not ideal."

That practice is known as "boarding," which Solomon said has become widespread around the country.

Stamford Hospital uses a "bed ahead" approach to speed up admissions from the ER. A doctor starts the hunt for a regular hospital bed as soon as a condition that will require admission, such as a hip fracture, is diagnosed, said Dr. Jayson Podber, chairman of Stamford's department of emergency medicine.

Podber said his ER has also reduced its average waiting time to 19 minutes by having a doctor perform triage.

"It's more efficient to have one doctor at the front, meeting ambulances and ordering the appropriate tests,'' he said.

Posting times

In 2009, Middlesex began posting its ER waiting times on a website, which has 36,000 direct hits a year, spokeswoman Peg Arico said.

Dr. Jonathan E. Bankoff, medical director of Middlesex's emergency department, said it's one way for ERs to market their services.

"We welcome, if you will, a bit of friendly competition," he said.

Windham, The Hospital of Central Connecticut, Johnson Memorial Hospital in Stafford and St. Francis Hospital and Medical Center in Hartford also post ER waiting times on their websites. The Hospital of Central Connecticut also has an iPhone app for patients to check waiting times, and St. Francis even lets patients "check in" to the ER through its website.

Stamford's Podber said one downside to posting times is that it can give patients a false expectation.

"It's not like you're taking a number at the deli," he said. "People come in who are a higher priority and need to be seen more quickly and that gets lost.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).

Data from Medicare.gov. The bigger the bubble, the longer the wait. Click on individual bubbles to get hospital information.